We take our feet for granted most of the time. They get us out of bed in the morning, take us on a jog around the neighborhood, and keep us moving all day long. We squeeze them into high heels, pound them on miles of pavement, and ignore their minor aches. Only when foot and ankle pain suddenly stops us in our tracks, literally, do we put our feet up and take notice.
Have you ever seen a reflexology chart of the foot? Reflexologists believe that each part of the foot is connected to another part of the human body. Problems in the body may be felt in the foot and treatment of the foot may help pain in the body according to this theory.
We know that the entire human body is interconnected, and that is certainly true with our feet as well. The feet act as the foundation for all motion and function. Pain in one area may be caused by something going on in a completely separate part of the body. At Warner Orthopedics and Wellness, we investigate foot and ankle pain with a full body exam to understand where the foot pain is coming from, and how it is affecting the whole body. Often, someone that presents with ankle pain will be found to have a dysfunctional hip that is causing them to walk and run poorly; this causes the ankle pain. If the leg and hip are ignored, this will not be discovered and the foot will remain painful.
Based on the location of pain, a diagnosis is usually straightforward, and may be corroborated using a simple x-ray or blood test. Dr. Warner treats all of the following common foot and ankle conditions on a daily basis:
Toe Pain - Conditions:
- Corns– Caused by continuous pressure on the sole of the foot, corns are a painful thickening of the skin that often reoccurs. These are similar in nature to the calluses found on the fingertips of a guitarist. Conventional treatment includes corn caps and cryosurgery, wearing shoes with insoles and a good fit. However, it is important that your doctor recognize and treat the source of the pressure as well, or the callus will simply return.
- Gout– Gout is a form of arthritis that deposits uric acid crystals in joint tissues. These crystals are small, sharp spikes of minerals that attack the joint surface. Gout symptoms occur rapidly and frequently start with severe pain in the dead of the night. Often a gouty attack will happen after a heavy meal, particularly one with red meat. Treatment includes non-steroidal anti-inflammatory drugs, colchicine, aspirin, and allopurinol therapy to keep the uric acid levels under check and prevent recurrence. Occasionally, injections or surgery is necessary. Topical pain creams are quite effective for this problem. A natural remedy with good effectiveness are tart cherries.
- Hammer toes– Chronic use of small, ill-fitted or high-heeled shoes can make toes hurt. The shoes may cause the toes to take on a peculiar bent shape that looks like small hammers. Usually, hammer toes are caused by genetics and shoes simply make them symptomatic. Treatment options include avoiding shoes that make the hammer toes hurt; a cobbler may stretch the upper of the shoe and give more room for the toes; stretching and strengthening exercises for the toes; painkillers, both oral and topical; insoles; and in extreme cases orthopedic surgery might be required. Hammer toe surgery is relatively straightforward, At Warner Orthopedics hammer toe surgery is done with implants that stay under the skin and one is usually walking within a week of surgery, if not the same day!
- Bunions– Abnormal bony prominences at the joint of the great toe are called bunions. This condition may be very painful and should to be remedied before it become a permanent deformity. Bunions are a genetic condition and are typically progressive; that is, they will increase or become worse over time. This worsening occurs regardless of shoe wear. Causes and treatment are the same as for hammer toe. Treatment starts conservatively, but often surgery is required. Bunion surgery at Warner Orthopedics and Wellness is done in such a way as to allow for maximum function at the earliest time possible (usually walking within 2 weeks).
- Arthritis– The most common reason for joint pain anywhere in the body, arthritis is joint inflammation that often occurs in adults older than 50. Foot pain may often be caused by arthritis; treatment is similar as for arthritis in the knee or hip. Painkillers, exercises, weight reduction, calcium, vitamin D can help to manage chronic arthritis. Physical therapy is a very effective treatment for arthritis. Arthritis is a complex problem and will be discussed in a later blog in more detail.
- Trauma– Any trauma to a joint in the foot can cause a fracture or a ligament tear or sprain. A fracture is a broken bone and treatment changes based on which bone is broken, how it is broken and also on patient characteristics. Fractures, or broken bones, should be evaluated by an orthopedic surgeon. Sprains or ligament tears may occur with trauma as well; sometimes soft tissue heal faster than broken bones. Treatment varies but may occasionally require no weight bearing on the affected joint for at least two weeks and some type of compression wrap along with ice, elevation and physical therapy.
- Plantar fasciitis– Plantar fasciitis is the degeneration of the ligaments and tendons below the heel can cause early morning foot pain. Usually this pain is due to damage to the plantar fascia. The plantar fascia is one of the most important stabilizers of the arch in the foot. The plantar fascia is also important in the function of the foot and in allowing for motion. This condition is extremely painful and can last up to 2 years. Treatment includes anti-inflammatory drugs, insoles, topical ointments, stretching exercises, rest and ice packs. Treatment may also include surgery, injections or physical therapy and/or acupuncture.
- Calcaneal spur– A bony ridge protruding from the heel bone (i.e. calcaneus) can cause a lot of heel trouble. It arises from the calcaneus (heel bone) near the plantar fascia and can be confirmed by a x-ray. Treatment options include pain-killers, topical ointments and orthopedic surgery. Treatment for heel spurs is often the same as treatment for plantar fasciitis. Surgery should be a last resort for this problem.
- Plantar Fasciitis– Arch pain can be pain due to plantar fasciitis involving the tissues of the foot arches. The symptoms and treatment is the same as plantar fasciitis affecting the heel.
- Fallen Arch– A fallen arch causes compression of the structures that are meant to be preserved by the arch, such as the nerves, blood vessels, ligaments, tendons and muscles. Wedges and insoles are the main line of treatment, however surgery is often needed for permanent resolution.
- Damage to tendons-…such as the posterior tibial tendon, may cause arch pain as well. If there is damage to this tendon, the arch becomes unstable. The posterior tibial tendon holds the highest point of the arch (apex) and stabilizes it. This tendon also initiates the push-off portion of the gait cycle. Tears or stretching injury to this tendon cause pain. However, damage to this tendon also cause significant instability and collapse of the arch.
Foot and ankle pain can be caused all of the above conditions, as well as a wide range of others that include nerve damage due to chronic diabetes, vitamin B-12 deficiency, or folic acid deficiency. An accurate diagnosis and treatment plan requires the attention of an orthopedic specialist.
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